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[Lyme borreliosis and cardiomyopathy]
J Bergler-Klein1, R Ullrich, D Glogar
1Abteilung für Kardiologie, Klinik für Innere Medizin, Wien.
Insights
Lyme carditis presents as acute, self-limiting heart conditions or chronic heart failure. Diagnosis involves serology and biopsy, guiding antibiotic treatment for Lyme disease affecting the heart.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Microbiology
Context:
- Lyme carditis is a cardiac manifestation of Lyme disease.
- It can present in acute or chronic forms.
- Diagnosis and treatment remain areas of clinical importance.
Purpose:
- To delineate the clinical presentations and diagnostic considerations of acute and chronic Lyme carditis.
- To review the etiological evidence and diagnostic criteria.
- To outline current antibiotic treatment strategies.
Summary:
- Acute Lyme carditis typically involves transient heart conduction disorders and rhythm disturbances.
- Chronic Lyme carditis is characterized by heart failure, supported by positive serology and endomyocardial biopsy.
- While serology and biopsy findings suggest Borrelia burgdorferi infection, they are not definitive etiological proof.
- Histological detection of spirochetes or cultivation from biopsy also requires careful interpretation.
- Antibiotic therapy, including oral penicillin or parenteral cephalosporins, is indicated based on disease severity and duration.
Impact:
- Clarifies the distinct clinical pathways of Lyme carditis.
- Highlights the diagnostic challenges and the importance of confirmatory testing.
- Provides guidance on appropriate antibiotic selection and duration for effective management of Lyme carditis.
Abstract:
According to current opinion there is acute, self-limiting Lyme carditis, and chronic Lyme carditis. Acute Lyme carditis manifests mostly as transient conduction disorders of the heart (e.g. AV-blocking I to III), and as supraventricular and ventricular rhythm disturbances, pericarditis, myocarditis, and pancarditis in single cases. Chronic Lyme carditis is defined as a case of chronic heart failure confirmed by positive serology and endomyocardial biopsy. Anamnestic aid is rare. Neither tick-bites nor preceding or accompanying erythema chronicum migrans are constantly reported. Seropositivity and control of its specificity by western blot are indicative but no etiological proof. Even histological detection of spirochetes in endomyocardial tissue or cultivation of borrelia from endomyocardial biopsy are no final etiological proof of the respective cardial disorder. Those findings, however, are an indication for antibiotic treatment. According to the severity of the disorder, antibiotics are administered orally (penicillin or derivatives) or parenterally with penicillin or cephalosporins of the 3rd generation over 4 and 2 weeks, respectively.